Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What additional work up would you do for a T1bN2 squamous cell carcinoma of the true larynx if endoscopy demonstrates a true cord lesion extending to the commissure with normal mobility and no evidence of supra or subglottic extension?
I assume that PET-CT was performed and demonstrated only the neck and the laryngeal lesion. The histology of VC cancer is usually well-differentiated. I would examine a needle biopsy of the nodes for discrepancy in histology and stain for p16 for the possibility of a second, unknown primary, which t...
Would you offer adjuvant therapy for patients with resected NSCLC <3 cm with visceral pleural involvement and no lymph node involvement?
The short answer is "no", I do not typically recommend adjuvant systemic therapy or radiotherapy for people with completely resected, small (<3 cm) T2aN0M0, stage IIA NSCLC.The NCCN guidelines state that "adjuvant chemotherapy is recommended for high-risk features" in people with resected stage IB o...
What criteria would you consider to select patients for 20 Gy consolidative RT in DLBCL/HGBL?
The primary endpoint of the study was 5-year local control. The study was powered to estimate this endpoint after the last patient had at least 2 years of potential follow-up (which will be reported at ASTRO). Local failures after 2 years are uncommon. The estimated 5-year freedom from local recurre...
Do you offer adjuvant osimertinib to EGFR exon 19 deleted patients with T2N0 NSCLC treated with definitive SBRT?
Given the fairly striking benefit of ADAURA in resected patients, there likely would be a locoregional and distant control and likely survival benefit to this approach but we don't have data to support this. PACIFIC-4 is currently enrolling. Study of durvalumab vs placebo in patients with early stag...
What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?
Hope for the miracle yourself! Broaden: “Are there any other things you are hoping for?” Hope for the best, prepare for the worst: “I see how much you want a miracle. I wonder if we can talk about what we should do if this doesn’t happen.” Consider involving a religious leader if relevant.
If adjuvant radiation is offered to an elderly patient with H&N SCC s/p Mohs surgery who is planned for multi-stage reconstruction of the defect with plastic surgery, when should adjuvant radiation be started?
Tumor control comes first. If the surgical defect is such that reconstruction is required, it is even more imperative to focus on the above principle, as a recurrence would almost certainly risk ruining the entire collective effort. Vascular flaps could be safely performed post-RT in most cases by s...
Are there patients for whom CROSS followed by surgery and adjuvant nivolumab should still be considered, following data from MATTERHORN and ESOPEC?
ESOPEC does not invalidate CROSS—it redefines the preferred option for fit patients; in the real world, not every patient will be able to tolerate FLOT or d-FLOT: Yes. Despite the emergence of perioperative FLOT-based strategies from ESOPEC and MATTERHORN, CROSS, followed by surgery and adjuvant niv...
For treatment with EBRT for H&N cancers, what is the consensus for CT simulation?
I agree with Dr. @Dr. First Last regarding the impact of CT contrast on IMRT/VMAT-based planning. Although I do not routinely perform a contrast and a non-contrast scan on H&N patients. The impact of IV contrast on IMRT dose distribution has been extensively studied, and the impact on the H&N region...
What are the treatment options for a patient with unfavorable intermediate risk PCa who desires future child bearing?
The best option for such patients would be sperm banking prior to treatment, whether they undergo RT+ADT or surgery. See this prior post on this forum regarding the impact of RT on fertility. Given the expected internal scatter dose to the testes during a course of fractionated RT, it would not be s...
Is ultrahypofractionation appropriate for a B51 candidate receiving breast-only radiation?
"I believe in the data of biologic equivalence, and I just treated patient X with ultrahypofractionation (UHFRT)...but I can't treat patient Y (who looks extremely similar to patient X, with a few idiosyncrasies) with UHFRT...because '"reasons"' ...*scratches chin* Hard as it may be to believe, ther...